The pipeline procedure is a relatively new approach for treating an unruptured aneurysm in the brain. With fewer risks and a shorter recovery time than the widely used clipping and coiling procedures, the pipeline procedure also offers a solution for certain kinds of aneurysms previously considered too difficult to treat surgically.
If your doctors have determined that the pipeline procedure for aneurysm treatment is the best option for you, it is important that you familiarize yourself with what is going to occur, prior to undergoing the procedure.
What Is the Pipeline Procedure?
An aneurysm is a weakened area in an artery wall that fills with blood and balloons outward from the parent artery. Although some aneurysms go undetected throughout life, these blood-filled sacs can enlarge, bleed or burst, causing stroke, neurological damage and even death.
Treatment of an aneurysm depends on factors including the size, location and shape of your aneurysm, whether or not it has ruptured, as well as your age and general health. In some aneurysm cases, doctors may opt to watch and wait. In many cases, aneurysms are treated by surgical procedures that are designed to stop the flow of blood to the aneurysm by placing a clip around its “neck” or filling it with coils of fine platinum wire, but these procedures aren’t appropriate for everyone.
Clipping and coiling procedures treat the aneurysm itself, while the pipeline procedure affects the artery next to the aneurysm. The pipeline procedure is very different in that it’s a more effective option for certain kinds of unruptured aneurysms. In this minimally invasive procedure, a wire mesh sheath called a pipeline embolization device, or PED, is inserted into the artery next to the aneurysm. This blocks the flow of blood to the aneurysm so that within a period of six weeks to six months, it shrinks and disappears.
This minimally invasive procedure is performed in a hospital and can take from 1.5–3 hours. Preparing for a pipeline procedure generally begins a few days before the surgery date.
Getting Ready for a Pipeline Procedure
In the days leading up to your pipeline procedure, you can expect to have a series of imaging tests such as a cerebral angiography or MRI to establish the precise size, location and shape of the aneurysm. Pre-surgery preparation also includes a complete medical history, blood tests and a neurological exam.
Your doctors will also prescribe anticoagulant medications, or blood thinners, such as aspirin or clopidogrel (Plavix). If you already take medications for other health conditions, you may be asked to discontinue them or adjust your dose. A surgery date will be scheduled and you will receive a set of preoperative instructions.
The Day of Your Surgery
Pipeline surgery is typically performed under general anesthesia, so you will be told not to eat or drink for 6–8 hours before surgery. Since the catheter carrying the PED is inserted through the femoral artery in the groin, that area is shaved. This is the only incision required in pipeline surgery.
Your surgical team includes your endovascular surgeon and the surgeon’s assistant, an anesthesiologist and circulating nurses, as well as a brain imaging specialists responsible for conducting real-time imaging of the aneurysm and arteries involved in the procedure. With the aid of contrast dyes to increase visibility, surgeons insert a microcatheter into the femoral artery and guide it to the site of the aneurysm with the help of a guide wire.
When the catheter reaches a point in the blood vessel just beyond the aneurysm site, the PED is released. The pipeline device opens, spreading from one wall of the artery to the other across the opening of the aneurysm, blocking its blood supply. When the PED is in place, the catheter is withdrawn and the incision is closed.
Recovering After Surgery
Immediately after surgery, you can expect a brief stay in the recovery room, where you will be monitored while waking up from anesthesia before being moved to a standard room. Without complications, you can expect to go home within a day or two.
In the first days of your recovery at home, your activities may be limited, so it’s important to have some help with household chores, especially involving lifting. Along with medications for pain, you’ll continue taking blood thinning medication until your doctor instructs otherwise. Full recovery generally takes 1-2 weeks, but you can expect to return to work or school within a few days to a week.
In the weeks and months after your pipeline procedure, follow-ups with your medical team will be scheduled to monitor your healing and check for any complications from. Within 3–6 months after surgery, a cerebral angiography or other imaging tests may be done to evaluate the placement of the pipeline device and check the status of the aneurysm. In the weeks and months after the procedure, your doctors will recommend that you continue taking an anticoagulant such as aspirin or Plavix.
The pipeline procedure is a minimally invasive and less risky way to treat unruptured cerebral aneurysms, especially those considered too difficult to treat by clipping or coiling. If your healthcare team has determined that the pipeline procedure is right for you, knowing what to expect at every stage of the process can make it easier to recover and get back to your everyday life as quickly as possible.
